Vomiting and abdominal pain are common in patients in the emergency department. This article focuses on small bowel obstruction (SBO), cyclic vomiting, and gastroparesis. Through early diagnosis and appropriate management, the morbidity and mortality associated with SBOs can be significantly reduced. Management of SBOs involves correction of physiologic and electrolyte disturbances, bowel rest and removing the source of the obstruction. Treatment of acute cyclic vomiting is primarily directed at symptom control, volume and electrolyte repletion, and appropriate specialist follow-up. The mainstay of therapy for gastroparesis is metoclopramide.
Key points
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Small bowel obstructions represent 15% of emergency department visits for acute abdominal pain and can be associated with significant morbidity and mortality if unrecognized and untreated.
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Computed tomography scans have become the mainstay of diagnosis, and management should be designed to correct physiologic and electrolyte disturbances, allow bowel rest, and remove the source of the obstruction.
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Cyclic vomiting syndrome is a poorly understood condition characterized by recurrent episodes of intense vomiting, which is treated acutely with antiemetics, fluids, and electrolyte replacement, although, among adults, cannabinoid may represent a previously under-recognized cause.
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Gastroparesis is a chronic motility disorder of the stomach that involves delayed gastric emptying without evidence of mechanical obstruction.
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First-line therapy in the emergency department is the use of metoclopramide, but domperidone, erythromycin, and antiemetics are also often used, and interventional therapy should be reserved for refractory cases.
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